Cryptogenic emboli in patients with patent foramen ovale or atrial septal defect associated with the use of nonsteroidal anti-inflammatory drugs.
BACKGROUND
Nonaspirin, nonsteroidal anti-inflammatory drugs (NANSAIDs) have been associated with arterial thromboembolic events in the general population. Our objective was to determine the prevalence of NANSAID use in patients diagnosed with cryptogenic emboli or paradoxical embolic events from a patent foramen ovale (PFO) or atrial septal defect (ASD) compared with a control population with an incidental PFO/ASD and no history of embolic events.


METHODS
We performed a retrospective case-control study of 90 age-matched patients to assess the association of NANSAIDs with cryptogenic arterial embolic events in patients with and without a history of PFO/ASD. Odds ratios (ORs) were obtained by chi2 analysis. Multivariate analysis was conducted with a logistical regression method.


RESULTS
Patients with cryptogenic embolic events had a high prevalence of prescription NANSAID use regardless of the presence of a PFO/ASD and were far more likely to have a history of NANSAID use than those with an incidentally discovered PFO/ASD and no history of arterial emboli (OR 4.30, 95% confidence interval 1.14-13.07, p = 0.01).


CONCLUSIONS
Many patients previously diagnosed with paradoxical emboli may be experiencing the prothrombotic effects of NANSAIDs rather than a paradoxical mechanism for their arterial embolic event.
Ferguson
Michael A
MA
Department of Cardiology, National Naval Medical Center, Bethesda, MD 20889, USA. drmfergus@yahoo.com
Mackay
Steven M
SM
Ramchandani
Suneil R
SR
Thurber
John S
JS
Curran
Michael J
MJ
DeGraba
Thomas J
TJ
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D019320:Embolism, Paradoxical / Q000139:chemically induced*; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications*; D006344:Heart Septal Defects, Atrial / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal